What is blood in the urine, hematuria?

The presence of blood and blood cells (erythrocytes) in the urine, either visually or under a microscope."hematuria" or "bloody urine"This is called hematuria. It can be visible to the naked eye (gross hematuria) or detected in a urine test (microscopic hematuria). In both cases, it is important to determine the cause of the bleeding. Blood in the urine is a cause for concern, and although the cause is often harmless, blood in the urine (hematuria) can be a symptom of a serious illness, primarily bladder cancer, but also kidney and prostate cancer, kidney and urinary tract stones.

When even a small amount of blood mixes with urine, it can be seen as a color ranging from pink to dark red, depending on the amount of blood. Blood in the urine is usually painless; however, pain may occur if there are blood clots in the urine, leading to obstruction, or if an infection is present. Even microscopic hematuria can occur without any symptoms, and it can persist for years without the patient noticing. The presence of blood in the urine, which can be a symptom of many serious illnesses, requires immediate medical attention. Some laxatives and medications containing dyes like azo dyes, as well as certain foods (beets, strawberries, raspberries, blackberries, etc.), can color the urine red without the presence of blood. Blood in the urine can also appear after strenuous exercise (especially long-distance runners), but it usually returns to normal within a few days. Other risk factors for hematuria include age and certain hereditary diseases.

Causes of Hematuria

When urine is examined under a microscope, the maximum number of blood cells (erythrocytes) normally seen is around 1-2 in men and 3-4 in women. Blood in the urine can originate from any area, from the kidneys, ureters, bladder, prostate, and urethra (the urinary tract where urine is expelled). Kidney and urinary tract stones, infections, and cancers are the most common serious causes of blood in the urine. In those under 40, it is more often due to urinary tract infections and stone disease, while in those over 40, hematuria may be a sign of urinary tract infections, prostate enlargement, prostate cancer, kidney cancer, or bladder cancer.

1- Kidney and urinary tract infections:In cases of microbial infections of the kidneys and urinary tract (cystitis, pyelonephritis, urethritis, etc.), blood may occur in the urine, but this bleeding is usually accompanied by difficulty urinating, burning, pain, and a frequent urge to urinate. In addition, an urgent need to urinate and foul-smelling urine may be present. If the infection is in the kidney, fever and flank pain may also occur. In prostate infections, difficulty urinating and a frequent urge to urinate are more prominent symptoms besides bleeding.

2- Urinary tract stone disease:Kidney and urinary tract stones that do not cause obstruction in the urinary tract may only manifest as blood in the urine; however, if they cause obstruction, the bleeding is accompanied by severe colic pain. If an infection is also present, the situation becomes even more complex.

3-Prostate enlargement:Prostate enlargement, which is more common in men over 40, can cause bleeding in the urine in addition to the patient's primary complaint.

4-Kidney diseases:Hematuria can be observed in some medical conditions affecting the kidney's non-microbial filtering units, such as glomerulonephritis; these can be a sign of kidney failure that may even lead to transplantation. Blood in the urine also occurs in diseases affecting the kidney's filtering system, known as nephritis. Furthermore, blood in the urine can be an additional finding in some systemic diseases such as diabetes.

5- Urological Cancers:The most important and serious cause of blood in the urine, whether clotted or unclotted, visible to the naked eye or microscopic, may be urological cancers.One of the most important symptoms of prostate and other urological cancers, especially bladder and kidney cancer, is blood in the urine. In fact, traditionally, men over 40 who smoke and experience painless, clotted blood in their urine are considered to have bladder cancer until proven otherwise.A common factor accompanying bleeding is smoking. While persistent blood in the urine is seen in both the early and long-term stages of bladder cancer, it is more common in advanced stages of prostate and kidney cancer.

6-Other reasons:Blood in the urine can occur in inherited genetic diseases such as sickle cell anemia and Alport syndrome, in kidney and urinary tract traumas, and with certain medications. Anticancer drugs like cyclophosphamide, radiotherapy, blood thinners like aspirin, and penicillin-type antibiotics can cause serious bleeding in the urine.

DIAGNOSIS

1- History and physical examinationIt is the first step in investigating hematuria.

2- Simple urine test:Even if there is visible bleeding, a simple urine test is necessary to determine if there are any additional findings. The urine should be visually examined in a clear container. If there are signs or symptoms suggestive of infection, a urine culture is taken.

3-Basic routine blood testsThis should definitely be requested from patients complaining of hematuria.

4- Imaging tests:Ultrasonography, being readily available and feasible, is the primary diagnostic method for patients with blood in the urine. In addition, computed tomography (CT) and magnetic resonance imaging (MR) may be requested when necessary.

5-Cystoscopy:If other methods fail to yield results, cystoscopic (endoscopic) examination may be necessary. Cystoscopy is a primary diagnostic method used to examine the bladder and urethra using a lighted, camera-equipped endoscope called a cystoscope. It is primarily used for bladder cancer, but also for other clinical conditions (stones, tumors, prostate problems, etc.).

6- Sometimes the cause of blood in the urine cannot be found.In this case, regular follow-up may be recommended, especially if there are risk factors for bladder cancer, such as smoking, exposure to environmental toxins, or a history of radiation therapy.

TREATMENT

Treatment for blood in the urine involves eliminating the underlying cause of the bleeding. Bleeding is not a disease itself, but a symptom of an existing condition; when the underlying disease causing the bleeding is treated, the hematuria is also treated.